The contrast between President Bush's Medicare reform proposal
and the national health scheme unveiled by Bill and Hillary Clinton
seven years ago is as stark as the difference between a free-market
democracy and a paternalistic socialist state.

A free-market democracy trusts its citizens, who are, after
all, the consumers who use - and in most cases, pay - for the
government's services.

A free-market democracy believes its citizens have the right
to exercise their vote in the marketplace and that they should
be able to ponder as many choices as possible before making a
decision.

Paternalistic states, on the other hand, believe that control-hungry
politicians and government bureaucrats can make better decisions
for individual consumers than the consumers themselves. Since
more choices mean less control by central planners, they offer
the people as few choices as possible. Consumer desires are tied
to a Procrustean bedstead and lopped off until they fit government
regulations. All in the name of the people, of course.

We all remember the fate of Hillarycare. The President put
his wife, Hillary, in charge of his much-ballyhooed national health
care initiative. After nearly a year and a half of secret meetings,
she unveiled a plan that made the creaky old medical systems of
Canada and Great Britain seem like shiny examples of rational
modernity.

The Hillary creation would have transferred one-seventh of
our nation's Gross Domestic Product from the private sector to
government control. The cost, indeed, was so prohibitive that
the normally free-spending Democrats - who ruled Congress at the
time - threw it out summarily.

That was the last major health care initiative launched by
President Clinton. In 1997, he even turned down the recommendation
of his own Bipartisan Commission on Medicare Reform - ignoring
its warning that the hour for an overhaul was drawing late.

President George W. Bush, just six months into his new administration,
has chosen a wiser course. A health care plan that trusts the
people who are the patients as well as the people who work in
the private health sector to make the right choices and do the
right thing.1

The Bush proposal does not call for anything so far-reaching
as national health care, but it does recognize that Medicare itself
must undergo sweeping reforms if it is to remain solvent and to
continue delivering quality health care in the first half of the
21st century.

It addresses one of the nation's most pressing needs, according
to ongoing public opinion polls, by providing prescription drug
discounts for needy seniors through private insurers.

Under the proposal, companies that manage drug benefits would
buy prescription drugs in bulk, and then sell discount cards to
Medicare patients, who could use them at any pharmacy to purchase
their medicines at deep discounts - up to 40% in some cases.

White House advisers believe the plan does not require congressional
approval because it relies on the private sector. They say the
Department of Health and Human Services could implement it in
a few months - bringing instant price relief to millions of seniors.

The remainder of the President's principles for Medicare reform
will undergo intensive scrutiny in the months ahead. They will
be the subjects of passionate debate.

Perhaps because President Bush no longer controls the Senate
and his bully pulpit is normally drowned out by a liberal media,
he has offered a plan of moderate principles short of the kind
of details that would engender immediate and bristling opposition.

In this instance, moderation is the right course. As long
as the President's vision is far-sighted, and it appears to be
in this case, Congress can flesh out the details. To do so, each
side will have to accommodate each other and make numerous concessions
along the way.

Is such an approach even a possibility in this era of "scorched
earth" politics? It is heartening - and perhaps ironic -
to consider that Democrats and Republicans were able to put their
differences aside and find common ground on an equally momentous
issue only a few years ago. It was called the Breaux-Frist Bipartisan
Commission on Medicare Reform.

Every member of Congress should remember Jefferson's famous
admonition as they consider this crucial piece of legislation.
In this undertaking, they should be neither Democrats nor Republicans.
They should be only Americans.

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Amy Ridenour is president of The National Center for Public Policy Research, a Washington, D.C. think tank. Comments may be sent to [email protected].